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COMPLIANCE INFO_2021
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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1600 - Food Program
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PR0547084
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
9/28/2021 11:30:48 AM
Creation date
9/28/2021 8:33:59 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0547084
PE
1608
FACILITY_ID
FA0026699
FACILITY_NAME
KAI'S KITCHEN 808
STREET_NUMBER
1263
Direction
S
STREET_NAME
PALERMO
STREET_TYPE
LN
City
MOUNTAIN HOUSE
Zip
95391
CURRENT_STATUS
01
SITE_LOCATION
1263 S PALERMO LN
P_LOCATION
03
QC Status
Approved
Scanner
SJGOV\jcastaneda
Tags
EHD - Public
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SANJ O A Q U I N Environmental Health Department <br />couINr <br />9. Employee: Initial if you agree to abide by the following: <br />I understand that I may not have more than one full-time equivalent cottage food employee, not including a <br />family member or household member of the cottage food operator, working within the registered or permitted <br />area of a private home where the cottage food operator resides and where cottage food products are prepared <br />or packaged for direct, indirect, or direct and indirect sale to consumers. <br />10. Delivery Limitation: Initial if you agree to abide by the following: <br />I understand that I may accept orders and payments via the internet, mail or phone. However, all "Class A" and <br />"Class B" CFO products must be delivered directly (in person) to the customer. The CFO products may not be <br />delivered via the United States Postal Service, UPS, FedEx, or using any other indirect delivery method as <br />deliveries are regulated by, and subject to, CDPH registration and state and federal requirements. <br />11. Owner's Statement: <br />Kainoa Garcia , agree to grant access to the local health department to <br />conduct an inspection of my cottage food operation (mark one) <br />® "Class A": In the event of a consumer ❑ "Class B": For regular annual facility <br />complaint or reported food -borne illness inspections and in the event of a consumer <br />complaint or food -borne <br />Kainoa Garcia , agree to notify the San Joaquin County <br />Environmental Health Department prior to modifying my food list, type of operation, and/or method of <br />selling, distributing, or otherwise providing my CFO products to the consumer or retailers, regardless of <br />whether the product is sold, consigned, or given away. <br />C�G110�c� G2ciw /f G1//7UC� �-rc�rc/o,� 2! <br />Owner's Signature Print Name Date <br />5 of <br />EHD 16-27 6129117 CFO REG/PERMITTING FORM <br />
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